Field of Work: Testing the use of evidence-based models in primary care to counsel patients to change their unhealthy behaviors.
Problem Synopsis: Four unhealthy behaviors—tobacco use, unhealthy diet, physical inactivity and excessive alcohol consumption—are the leading causes of preventable disease, disability and premature death in the United States each year. What's more, the Big Four occur in clusters: using data from the National Health Interview Survey for 2001, researchers found that a majority of adults reported two or more of these risk factors.
Failure to address these behaviors is costly: spending on heart disease, diabetes and other chronic conditions linked to the behaviors accounts for up to 70 percent of U.S. health care costs, according to the Centers for Disease Control and Prevention (CDC). Even modest reductions in behavior-related risks could improve Americans' health and reduce health care costs.
Synopsis of the Work: Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks—a national program of the Robert Wood Johnson Foundation (RWJF)—tested the use of evidence-based models and innovative tools in primary care to counsel patients to change the four unhealthy behaviors.
Launched in August 2002, Prescription for Health targeted "the largest single platform of health care delivery—the offices of primary care clinicians—to discover what it actually takes to help individuals make and sustain healthier choices," according to the National Program Director. Prescription for Health funded 22 practice-based research networks (PBRNs).
- Diverse primary care practices in the 22 PBRNs deployed a wide range of tools and techniques to address multiple behavioral risk factors among their patients.
- To address health-related behaviors, primary care practices had to undergo substantial redesign.
- To help patients change behavior, primary care practices created a "bridge" connecting them with community resources.
- The program drew from several models and strategies to guide the design of the interventions.
- The effectiveness of clinicians in promoting healthy behaviors and the quality of their service to patients are probably maximized when practices have systems in place to support the entire counseling sequence, rather than simply components of the process.
- Primary care practices that incorporate behavioral health counseling incur startup costs and continued expenses that payers do not reimburse.
- Lessons about how patients changed behaviors reveal that these changes occur in the context of ongoing relationships with a personal physician and practice team.
- "Prescription for Health took off the table the misconception that primary care practices don't care about behavior, don't want to deal with it and are unable to support key national policy objectives, such as resolving the obesity epidemic," according to the National Program Director.
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